Reactivation from Retirement

Downloadable Application Kit for Reactivation from Retirement

Please read the instructions carefully before completing your application.

Documents

• Reactivation from Retirement Kit 
• Reactivation from Retirement Letter 
• Instructions 
• Application Checklist 
• Application 
• Authorization for Release 
• Medicare Tax Form 
• Supplement Instructions 
• Malpractice History Form 

This information is provided by the Board of Registration in Medicine.